20050658.pdfDATE RECEIVED
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RERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER oil
CONSTRUCTION PERMIT APPLICATION JOB fj�'t SUITEtAPT#
ADDRESS
OWNER NAMEINAME OF BUSINESS I [k) I
PLAT NAM E/SUB DIVISION NO. LOT NO� LID NO.
MAILINGADDRESS LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREETMAP TESCPAprifovod [3
U) RW Pefiril Required 0
-fl A Seeel Use Permit Required 13
CITY ZIP TELEPHONE'-'/jZ6) :�,A,
10 EXISTING PROPOSED Inspoci,on Roouirud 13
SidoWalk Requifed E3
Unaluglound [3
2 REQUIRED DEDICATION FT I Wmrq required
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NOO z
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ADDRESS REMARKS z
OWNER/CON1 RACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 5
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CITY ZIP TELEPHONE
NAME CBL#
ENGINEERING REVIEWED BY DATE
'ADDRESS
FIRE REVIEWED BY DATE w
CITY ZIP TELEPHONE ce
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VARIANCE OR CU SHORELINEORADBO INSPECTION SEPA 0
REO'D COMPLETED EXEMPT -4
13YES M NO
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CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
00 004� 00 WAIVER f3 ALLOWED PROPOSED ALLOWID , PROPOSED
on C�� a 0 STUDY 13 tj /C.-
NEW )<�RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
1:1 ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR M
COMMERCIAL COMPLIANCE OR N z MID
El ADDITION 13 CHANGE OF USE z 0
MIXED USE PARKING LOTAREA PLANNING REVIEWED BY DATE -1 0
13 REMODEL 13 MULTIFAMILY SIGN REQ*D PROVIDED 0 Tj / t) Q. 0 r
11,00 .57
FENCE I N I I
FZ71 GRADING M
REPAIR 1:1 CYDS X FT.) REMARKS M z
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DEMOLISH 1:1 TANK Z,
-1 RETAINING WALL FIRE SPRINKLER ""SZ) V,�G W!ESdXA-cj OUID vrctL ue-7e,:-; >
GARAGE
CARPORT 1:1 ROCKERY FIRE ALARM
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: TYP �F CONST ICTION cob? OCCUPANT
04OULT- FAWL�j 15-1 GROUP o -n
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STORIES —UNITS LOAD
NUMBER NUMBER OF -A
OF DWELLING SPE L INSPI!CTION CONSULTANT OCCUPANT
REQUIRED M M
DESCRIBE WORK TO BE DONE
REMARKS 0
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GEOTECH REPORT
BY:
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STRUCTURAL DESIGN Z r-
BY.
7,r VALUATION
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on FEE Description FEE z
Descripti
Plan Check
state surcharge
HEAT SOURCE LOT SLOPE%— VESTED DATE z
, Building Permit 1Y) City Surcharge 0
PLAN CHECK NO:
Plumbing Base Fee 0
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
u
L PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
J
E EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
li ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
r FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Anit. Due
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL Building Official or hisdhcir Deputy: and Fees are paid, and
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF T14E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space p(ovided
WORKMEN'S �0"SATION INSURANCE AND RCW 18:27.
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LS SIGNAT DATE
k"ALSS
SIGNATU R;.tR A G E IN T) DATE SIGNED (425)
2 74)
BY
771-0220 1 DATF1
AT E T 1,e,? N EXT. 1333
IT IS FUL TO U OR OCCUPY A BUILDING OR STRUCTURE UNTIL
L I \ 0)tIGINAL FIL ELLOW - INSPECTOR
A FIVNL INISPECTIOiH(AS BEEN MADE AND APPROVAL OR A CERTI-
INK -OWNE� I
FICATE-OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. - GOLD - ASSESSOR
10104 PRESS HARD YOU ARE MAKING 4 CO IES' "'P
SECTION INSPECTiON CHECKLIST
YES NO
Home licensed (or applying for license) on or after July 1, 2001
SLEEPING ROOMS
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Sleeping Room. #1 S .0 NS1
Bedroom door is openable from the outside when locked
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Closet doors are readily openable from the inside
Smoke alarm is installed In the bedroom
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Sleeping room window has a minimum net openable area of 5.7 Sf. (minimum dimensions- 24" high; 20",-Wde)
sleeping room window has a maximum sill height of 44"
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Sleeping Room #2 0 S 0 NSI (�'NS2
Bedroom door is openable from the outside when locked
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Closet doors are readily openable from the inside
Smoke alarm is installed in the bedroom
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Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24"high; 20"wide)
Sleeping room window has a maximum sill height of 44"
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Sleeping Room #3 0 S 0 NSI eNS2
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Bedroom door is openable from the outside when locked
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Closet doors are, readily openable from the inside
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Smoke alarm is Installed in the bedroom
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Sleeping room Window. has a minimum net.openable area of 5.7 sf. (minimum dimensions 24" high; 20"Wide)
Sleeping room window has a maximum sill height of 44"
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Sleeping Room #4 O's 0 NSI 0 NS2
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Bedroom door is openable from the outside when locked
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Closet doors are readily openable from the inside
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Smoke alarm is installed in the bedroom
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Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide)
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Sleeping room window has a maximum sill height of 44"
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Sleeping Room #5 0 S 0 NSI NS2
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Bedroom door is openable from the outside when locked
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Closet doors are readily openable from the inside
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Smoke alarm is installed In the bedroom
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Sleeping room window has a minimum net openable area of 5.7'sf. (minimum dimensions- 24" high; 20" Wide)
Sleeping room Window has a maximum -sill height of 44"
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Sleeping Room #6 0 S 0 NSI� 0 NS2
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Bedroom door is openable from the outside when locked
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Closet doors are readily openable from the inside
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Smoke alarm is installed in the bedroom
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Sleeping room window has a minimum.net openable area of.5.7 Sf. (minimum dimensigns- 24" high; 20"wide)
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Sleeping room window has a maximum sill height of 44"
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GENERA
Bathroom doors are openable from the outside when locked
Smoke alarms are installed on ail levels, of the dwelling
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All smoke alarms are audible In all parts of the dwelling upon activation of a single device
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Access road and water supply approved by Fire Department
N'PASSED a- 0 ECTIONS REQUIRED 0 PERMIT
REQUIRED
DATE:
INSPECTOR:
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MID
1. Covenant: Limitation on Residence. The owner hereby stipulates
aiida s that occupancy of the structure as an adult family home shall be limited
gree
�o or fewer adults and their caretakers as allowed by applicable
pro of state low. The owner acknowledges that In the event that the applicant
V ons;
$e*R&-revlslon of the applicant's state license to operate an adult family home with
pin .. occupapcy of greater than .3 residents. or attempts to rent, lease or
othgi��6 orovide residence for additional residents above the
..,-Oiisotted In the current occupancy classification, the structure shall
"eaca" and all irlesidential use ceased until such time as the property is brought
thto-c-o" * lanc e*.wi -the provisions of the State Building Code, under the edition of
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the U' or.diEi�&ng)Code then In effect. The owner further stipulates that this
cove'niknt qches A-0peerns the land so long as the present structure and use
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contin"ues.a w.1th the land to all future purchasers and assigns.
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Sdb 'Tract. The above stipulation and promises shall apply to and
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-respect to located at_J 11PI4 94y- IT W
run with theland Mth a residential structure
Edmonds, Washington and legally described as:
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.3. Notification to Future Purchase'r's'l�d*'ArAgne;es. This notification
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and covenant has been recorded In the records of SnoliiiWsh County, Washington
all fu
In order to provide notice to any and ture. ow.n.ers *of'tbe* property of the
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f, nillf" nd adult family
limitation at the current level of Improvement to ]single a es 4
home residents fewer than 4 in number�
4. Enforcement. In addition to any and othe� rekWies cIAL or criminal
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which the City may have, the property owner hereby agn es. and A44iiia that this
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juncilon-the-oroviAous of this
grant of covenant shall entitle the City to enforce by In 1. .
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code and, In s I o doing, to recover its reason I able attorney's feeg'aria cqsti**-
AUTHORIZED FOR RECORDING
Cibf of Edmonds
BY: -IM Date:
Paze 7— of 3
DATED th day of e e Pn 444
ACCEPTED BY; APPLICANTIPROPERTY
OWNER:
LOftTA H Tokwrh-
Applicant
Ap licant
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COVENANT AND
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ACKNOWLEDGED:
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Mortgagor
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.1y vci�*Clw- gi;i��TURES
NOTAI ... . ....
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Washington
State Of I
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I.certify that, I know OatISFACtoft evidence that a�&i"
the
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signed this Instrument; 6n-4th sUted that be/sbe Was authorized to execute
instrument and acknowledg.0ii as the (title) of
(name of party on behalf q�4hoMjnstriiment was ex ecuted) to be
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the free and voluntary act of such party"for the -6sis andipur
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this
Instrum enL Subscribed and swo to before me. -.13 ay of
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state of vinhko"
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BETTY CNA"TauisAL
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My AP00intMWd EX*119 Oct 22. 2
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PubUgindl'or th"e.te',of i, hj�n
My commission expires
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I certify that I know or have SaWOctO
signed this instrument, on oath stated � bat he/shA was a lithorlz& to*vxecute the
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Instrument and acknowledgewd It aws th .(titli)
(name 0 f party on beha If on whom IMAruthgnk wak-rieputed to be
the free and voluntary. act of such party for the uses finO PUrjWSe5.1fiintId this
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lnstr= ribed an d sworn to before me this
ent. Subsc
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Noi Public In I W te of Washin ...... .
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mf commission expires &M-L. -siite of Wbihingtort
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AUTHORIZED FOR RECORDING my�PPQI�hi%qftt lxpke�--O* 22, 2
C of Edmonds
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Page of
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMI C IN B LD G DIVISION
FROM: FIRE.DEPARTMENT DATE '51410 S
ASE SIUN
ENGINEERfNG DIVISION DATE
PlEASE SIGN
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PLANNING DIVISION DATE
PLEASE SIGN
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PROJECT
SITE ADDRESS
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PERMIT 4 S`8 ADB# DATE INSPECTEb
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine compliance with approved plans. Final. approval
denotes that th ' ere are. no objections from the aboVe signed Department to the release of
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PERFORAIANCE BONDS and the granting of
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GRANT FINAL PROJECT- APPROVAL
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GRANT'PROJECT APPROVAL WITH CONDITIONS NOTED
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El Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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E3 Copy of CORRECTION NOTICE given to owner/contractor by inpector.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fbnns:ocapn,1 3/25/04.
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .............. ......
FOUNDATION:
FOoting
Wall.........................
Pier/Porch ....... * .........
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground ............
Rough -in ..... * ..............
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment ................. .
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation . .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ...........
FINAL APPROVAL FOR
43
OCCUPANCY .......... ------
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